Walch G, Nove-Josserand L, Levigne C, Renaud E
From Clinique Emilie de Vialar, Lyon, France.
J Shoulder Elbow Surg. 1994 Nov;3(6):353-60. doi: 10.1016/S1058-2746(09)80020-7. Epub 2009 Feb 13.
Exploration of the rotator interval during repair of 116 apparently "isolated" supraspinatus tendon lesions have revealed "hidden lesions" of the coracohumeral ligament, the superior glenohumeral ligament, and the superior portion of the subscapularis tendon in 19 cases. Epidemiologic characteristics were comparable with other series with the exception of involvement of the dominant shoulder in 95%. Arthroscopic computed tomography documented the lesion in 85% of the cases. At surgery the superficial layer of the coracohumeral ligament was always intact. After splitting of the rotator interval the lesion was visible and consisted of a local disinsertion of the common insertion of the superior glenohumeral ligament and the coracohumeral ligament and the deep superior fibers of the subscapularis tendon. It measured 1 to 2 cm in the superior-inferior direction. The biceps tendon was ruptured in 2 cases, subluxated in 14, and in its normal position in 5. The treatment consisted of intraosseous reinsertion of the supraspinatus tendon, recentering of the biceps, and reinsertion of the torn structures to reconstruct a functional pulley system. The patients have been reviewed with a mean follow-up of 20 months (range 12 to 36 months). A secondary rupture of the long head of the biceps has been observed in 25% of the cases after recentering of the tendon.
对116例看似“孤立”的冈上肌腱损伤进行修复时对旋转间隙的探查发现，19例存在喙肱韧带、肩肱上韧带和肩胛下肌腱上部的“隐匿性损伤”。除95%为主肩受累外，其流行病学特征与其他系列研究相似。关节镜计算机断层扫描在85%的病例中记录到了损伤情况。手术中，喙肱韧带的浅层总是完整的。在劈开旋转间隙后，损伤可见，表现为肩肱上韧带和喙肱韧带共同止点以及肩胛下肌腱深层上部纤维的局部撕脱。其上下径为1至2厘米。肱二头肌肌腱2例断裂，14例半脱位，5例位置正常。治疗包括冈上肌腱的骨内重新附着、肱二头肌复位以及撕裂结构的重新附着以重建功能性滑轮系统。对患者进行了平均20个月（范围12至36个月）的随访。在肌腱复位后，25%的病例观察到肱二头肌长头再次断裂。
